Cardiology Coding Alert

Question: Does 434.x apply to a postoperative cerebrovascular accident (CVA)?

Maryland Subscriber

Answer: For a postoperative CVA, you should assign 997.02 (Iatrogenic cerebrovascular infarction or hemorrhage), according to the ICD-9 official guidelines (www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm). "Iatrogenic" means a physician inadvertently induced the infarction or hemorrhage through medical or diagnostic procedures.

You also should add a secondary code from cerebrovascular disease codes 430-432.x (subarachnoid, intracerebral, or other intracranial hemorrhage) or from 433.xx-434.xx (artery occlusion) with a fifth digit of "1" to identify the hemorrhage or infarct type.

Documentation check: The guidelines instruct that "the medical record documentation must specifically identify the cause and effect relationship of the procedure and the CVA."